We present a case of surgical management of a tracheoesophageal fistula (TEF) following prolonged intubation. After transverse tracheal division and retraction of the distal stump, direct closure of the esophageal defect and repair of the membranous tracheal defect using a synthetic bioabsorbable patch were performed, followed by interposition of muscle flap between the suture lines and tracheal reconstruction. Large TEFs, without tracheal stenosis or circumferential airway defect, associated with marked peritracheal inflammation, may be treated with this alternative tracheoplastic technique in patients deemed not suitable for tracheal resection and anastomosis.

Purpose: To evaluate the predictive value of stair climbing test (SCT) on postoperative complications in lung cancer patients with limited pulmonary function.

Methods: A total of 727 hospitalized lung cancer patients with limited pulmonary function were retrospectively reviewed. Included in the cohort were 424 patients who underwent SCT preoperatively. Patients were grouped according to general condition, past medical history, surgical approach, pulmonary function test, and SCT results. Comparison of the postoperative cardiopulmonary complication rates was made and independent risk factors were identified.

Results: A total of 89 cardiopulmonary-related complications occurred in 69 cases, accounting for 16.3% of the entire cohort. The postoperative cardiopulmonary complication rates were significantly different between groups stratified by smoking index, percentage of forced expiratory volume in one second, percentage of diffusion capacity for carbon monoxide, SCT results, excision extension, and anesthetic duration (p <0.05). Multivariate analysis showed that only height achieved (p <0.001), changes in heart rate (∆HR; p <0.001), and excision extension (p = 0.006) were independent risk factors for postoperative cardiopulmonary complications.

Conclusions: The SCT could be used as a preoperative screening method for lung cancer patients with limited pulmonary function. For those patients who could only climb less than 6 floors or had ∆HR >30 bpm in the test, sublobar resection should be selected to reduce the postoperative cardiopulmonary complication rate.

Purpose: The best treatment strategy for primary spontaneous pneumothorax is controversial and varies widely in practice.

Methods: Literatures were searched from databases till 24 August 2021. A Bayesian network meta-analysis was conducted to compare the outcomes of various treatments with the following endpoints: recurrence rate, postoperative chest tube duration, postoperative air leakage duration, length of hospital stay, and complications rate.

Results: In all, 7210 patients of 20 randomized controlled trials and 17 cohort studies were included. Surgery had a significantly lower recurrence rate compared to other treatments. Besides, bullectomy (BT) combined with chemical pleurodesis (CP), mechanical pleurodesis, or staple line coverage (SLC) can reduce the recurrence rate compared to BT alone, but none of them were statistically significant. In terms of reducing chest tube duration, BT with tubular Neoveil outperformed BT + pleural abrasion (mean difference [MD], 95% confidence interval [CI]: −2.5 [−4.63, −0.35]) and BT + apical pleurectomy (MD, 95% CI: −2.72 [−5.16, −0.27]).

Conclusions: Surgical methods were superior to manual aspiration (MA), chest tube drainage (CTD), and conservative treatment in terms of recurrence reduction. There was no significant difference between MA and CTD in reducing the recurrence rate. Among surgical methods, CP is more effective than mechanical pleurodesis and SLC among the additional procedures based on BT.

Purpose: Intraoperative complications, especially unexpected bleeding, are of great concern in the safety of thoracoscopic surgery. We investigated the hemostatic efficacy and safety of positive intrapleural pressure (PIP) with carbon dioxide insufflation by assessing the amount of blood loss in a pulmonary arterial hemorrhage model.

Methods: An ex vivo experimental model of saline flow into a swine vessel was created in a container simulating a chest cavity. From the results, in vivo experiments (swine model) were conducted to compare the pulmonary arterial bleeding volume while applying PIP.

Results: In the ex vivo experiment, regardless of the incision type, the outflow volumes did not significantly differ at flow pressures of 20, 30, and 40 mmHg. At each flow pressure, the outflow volumes at 10, 15, and 20 mmHg of positive pressure in the container were significantly smaller than those of the control (p = 0.027, p = 0.002, and p = 0.005, respectively). Similarly, the in vivo experiments showed that bleeding decreased as intrapleural pressure increased (slope = −0.22, F = 55.13, p <0.0001).

Conclusion: It may be possible to temporarily suppress pulmonary arterial bleeding by increasing the intrapleural pressure to 10 to 20 mmHg using carbon dioxide insufflation. This method may be an adjunctive hemostatic maneuver for intraoperative bleeding.

Purpose: We examined whether preoperative assessment of percentage of low attenuation area (LAA%) on the non-resected side can predict postoperative respiratory complications (PRC) after lobectomy.

Materials and Methods: We conducted a historical cohort study of 217 smokers (175 males and 42 females) who underwent lobectomy for primary lung cancer at our hospital between January 2014 and March 2021. First, the relationship between LAA% and respiratory function parameters (RFPs) calculated for both the bilateral and non-resected sides was used to estimate the most effective patient group. Next, multivariate analyses of the relationship between LAA% of the non-resected side and PRC were performed using logistic regression analysis after adjusting for basic patient attributes and respiratory function.

Results: A correlation was found between LAA% and RFP in smoking males. Multivariate analysis showed a strong relationship between model 3, adjusted for basic patient attributes and lung function factors, and PRC (odds ratio, 2.43; 95% confidence interval, 1.05–5.63).

Conclusion: LAA% of the non-resected side suggested that it may be able to predict the occurrence of PRC after lung cancer lobectomy.

Purpose: To compare malignant pleural effusion (MPE) treatment outcomes and complications among patients receiving indwelling pleural catheter (IPC), talc pleurodesis (TPS), or dual therapy. Outcomes were determined by measuring length of stay (LOS) and post-procedure dyspnea scores. Complications were measured by comparing intervention failures and adverse events.

Methods: The Veterans Affairs’ Corporate Data Warehouse was utilized to retrospectively review the charts of 314 MPE subjects. Dyspnea scores were estimated by researchers and LOS was determined by adding the duration of stay for all admissions post procedure. Complications were recorded through chart review.

Results: IPC exhibited higher failure rates than the other approaches 1 year post intervention. Pneumonia/chest infection rate and lung entrapment were also more prevalent. There was no significant difference in dyspnea rates. LOS illustrated a significant difference between groups, with talc patients spending a median of 7 days in the hospital immediately post procedure, while IPC and IPC + TPS patients spent a median of 3 and 2 days, respectively.

Conclusion: Patients receiving IPC or combination treatment spend fewer days in the hospital than TPS patients. However, IPC appears to be associated with more adverse events and higher long-term failure rates than other management strategies.

Purpose: Thermoreactive nitinol Flexigrip has been developed to ensure better fixation than conventional wire closure. To verify the advantage of Flexigrip over the conventional wiring, we compared early sternal bone healing on computed tomography (CT).

Methods: A prospective cohort study enrolled the first consecutive 80 patients with wiring and the second consecutive 44 patients undergoing Flexigrip sternal closure. The primary endpoint was sternal healing evaluated quantitatively using a 6-point scale and measured gaps/offsets of the sternal halves at 6 levels on CT scans on the 14th postoperative day. Secondary endpoints included pain scores and sternal complications 1 month after surgery.

Results: Compared with the patients of wiring, those who received Flexigrips showed higher 6-point scores at most sternum levels, less frequent gaps (52% vs 70%, p = 0.04), lower offsets (3.3 ± 0.9 mm vs 4.3 ± 0.7 mm, p <0.001) at the manubrium, and less frequent gaps (25% vs 43%, p = 0.04) and offsets (2.3% vs 24%, p = 0.002) at the middle of sternum. The pain scores and sternal complication rates were similar between both groups.

Conclusion: CT evaluation 2 weeks after surgery revealed that Flexigrip sternal closure showed less gaps and offsets of the sternal halves, suggesting faster sternal bone union when compared to the wiring.

We report a 33-year-old man who presented with recurrent right pneumothorax. Computed tomography (CT) showed the presence of a large bulla with a maximum diameter of 8 cm in the right middle lobe; he subsequently underwent bullectomy. Histopathology revealed that pulmonary parenchyma adjacent to the bulla represented nodular proliferation of clear cells characterized by a papillary structure resembling placental chorionic villi. Immunohistochemically, clear cells were positive for CD10, suggesting placental transmogrification of the lung (PTL). We reviewed 36 surgical cases of PTL, and only 2 cases (5.6%), including our case, were operated for spontaneous pneumothorax. Bullous lesions secondary to PTL tend to appear as unilateral large cystic masses in non-upper lobes, which is atypical for primary spontaneous pneumothorax (PSP). Although PTL is considered a very rare cause of secondary pneumothorax, we must carefully differentiate this condition.

A 48-year-old woman with extensive clarithromycin-resistant Mycobacterium avium complex pulmonary disease (MAC-PD) was successfully treated by left lower lobectomy and lingulectomy following combination treatment of intravenous/inhaled amikacin plus bronchial occlusion by Endobronchial Watanabe Spigots (EWSs). A left pneumonectomy was initially indicated for removing all the lesions, but the procedure would have been barely tolerated by the patient. However, her preoperative combination treatment sufficiently reduced the lesions requiring resection to allow surgical preservation of the left upper division. This novel approach might be promising for patients with Mycobacterium avium complex lung disease whose pulmonary reserve will not allow an extensive parenchymal resection.

Introduction: Stiff-person syndrome (SPS) is a rare autoimmune neurological disorder. Paraneoplastic SPS associated with malignant tumors such as thymoma occurs in approximately 5% of all SPS cases. We present a rare case of thymoma accompanied by SPS successfully treated using surgery.

Presentation of Case: A 26-year-old woman presented with lower limbs convulsions and gait disturbance and complained of leg pain. Cerebrospinal fluid and blood test results showed a high level of anti-glutamic acid decarboxylase (GAD) antibodies. Computed tomography showed anterior mediastinal tumor suggestive of a thymoma. She underwent extended thymectomy, and her symptoms gradually improved after surgery. No evidence of recurrent thymoma and SPS has been observed over 44 months.

Conclusion: Surgical treatment would be effective for patients with SPS and thymoma.